Is the flap reinforcement of the bronchial stump really necessary to prevent bronchial fistula?

Abstract

Background/aim The development of bronchopleural fistula (BPF) remains the most severe complication of lung resection, especially after pneumonectomy. Studies provide controversial reports regarding the benefits of flap reinforcement of the bronchial stump (FRBS) in preventing BPF’s occurrence. Methods This is a retrospective cohort study of 558 patients that underwent lung resection in a 12-year period (from 2007 to 2018). Ninety patients (16.1%) underwent pneumonectomy. Patient follow-up period varied from 1 to 12 years. Results Out of 558 patients in this study, 468 (83.9%) underwent lobectomy, and the remnant underwent pneumonectomy. In 114 cases with lobectomy, only 24.4% had FRBS, meanwhile in 56 cases with pneumonectomy only 62.2% had FRBS. BPF occurred in 8 patients with lobectomy (1.7%) and in 10 patients with pneumonectomy (11.1%). Among cases with post-pneumonectomy BPF, 6 (10.7%) had FRBS performed, while no FRBS was performed among patients with post-lobectomy BPF, although these data weren’t statistically (p > 0.05). In 24 patients (20 lobectomies and 4 pneumonectomies) with lung cancer (10.4%) neoadjuvant treatment was performed, in which 20 patients underwent chemotherapy and 4 underwent radiotherapy. FRBS was applied in each of the above 24 operative cases, but only in 4 of them the BPF was verified. Conclusion The idea of enhancing the blood supply through the FRBS for BPF prevention has gain traction. Although FRBS has been identified as valuable and effective method in BPF prevention following lung resection, our study results did not support this evidence.

The technique of stump closure has no impact on post-pneumonectomy bronchopleural fistula in the non-small cell lung cancer—a cross-sectional study

“…The literature describes the advantages of several types of autologous tissue buttressing, such as with IMF (28), pleura (27), pericardial fat pad (13,29), or diaphragm (28). A recent study by Caushi et al reported no significant differences between buttressed and non-buttressed bronchial stumps in the occurrence of BPF (30). Some studies consider IMF as a durable and blood supplyadequate material for bronchial buttressing (27,28).…”

Bronchopleural Fistula after Pulmonary Resection: Risk Factors, Diagnoses and Management

“…In a retrospective study, Taghavi et al, found 93 patients who underwent pneumonectomy for primary lung cancer, identified no BPF during follow up after using a pedicled pericardial flap for bronchial stump coverage [41]. A pericardial fat pad is harvested from the anterolateral pericardium, pedicled at its cranial part, avoiding inclusion or injury to the phrenic nerve [9,42].…”

Cell Therapy for Upper Respiratory Tract Fistulas

“…Наиболее распространенной причиной их появления является несостоятельность культи бронха после операций на легких [1,2]. В последние десятилетия совершенствование хирургической техники, антибиотикотерапия, улучшение послеоперационного наблюдения привели к снижению частоты развития несостоятельности анастомозов культи бронха с 28 до 3-4% [3,4]. По данным нашего центра, в послеоперационном периоде свищи развиваются в 2,4% случаев.…”